English for Psychiatry: Essential Vocabulary

"auditory hallucination"

A perception of hearing sounds or voices without any external auditory stimulus

"The patient reported persistent auditory hallucinations — commanding voices telling him to harm himself — which had begun three weeks earlier."

"thought insertion"

A first-rank symptom in which a person believes foreign thoughts are being placed into their mind by an outside force

"On mental state examination she described thought insertion, stating that the government was inserting ideas directly into her brain."

"ideas of reference"

The belief that random environmental events carry special personal significance directed at oneself

"He had marked ideas of reference, convinced that news presenters were sending him coded messages through the television."

"flat affect"

A severely reduced range and intensity of emotional expression, seen as a negative symptom of psychotic illness

"Throughout the interview the patient maintained flat affect, speaking in a monotone with no facial animation despite discussing distressing material."

"loosening of associations"

A formal thought disorder in which ideas shift between unrelated topics without logical connection

"The mental state examination documented loosening of associations — the patient moved from discussing the weather to medieval knights to molecular biology within a single sentence."

"prodrome"

The early, sub-threshold phase of psychosis preceding the full emergence of florid psychotic symptoms

"The early intervention team identified a classic prodrome: six months of social withdrawal, declining function, and attenuated perceptual disturbances."

"negative symptoms"

A cluster of deficits in normal function including alogia, avolition, anhedonia, and blunted affect, characteristic of schizophrenia

"Despite good response to antipsychotics for positive symptoms, the patient remained significantly disabled by negative symptoms including profound avolition."

"clozapine"

An atypical antipsychotic reserved for treatment-resistant schizophrenia, requiring regular haematological monitoring due to risk of agranulocytosis

"After failing two adequate trials of antipsychotics, the patient was commenced on clozapine with weekly blood monitoring for the first eighteen weeks."

"anhedonia"

The inability to feel pleasure in activities that were previously enjoyable, a hallmark symptom of major depressive disorder

"She described profound anhedonia — her lifelong love of painting had left her entirely; she could not bring herself to pick up a brush."

"psychomotor retardation"

A visible slowing of physical movement, speech, and cognitive processing associated with severe depression

"Psychomotor retardation was evident: responses were delayed by up to ten seconds and movement appeared slowed and effortful."

"flight of ideas"

A rapid, near-continuous stream of speech in which ideas shift quickly from topic to topic, typically seen in mania

"The patient exhibited flight of ideas, speaking at speed about plans to launch a business, travel the world, and write a novel simultaneously."

"grandiosity"

An inflated sense of self-importance, special powers, or unique identity, common in manic and hypomanic episodes

"His grandiosity was evident in the belief that he had been chosen by God to solve the world's economic crisis single-handedly."

"mixed affective state"

A condition in which features of both mania and depression occur simultaneously within the same episode

"The patient presented in a mixed affective state — elevated mood and pressured speech coexisted with tearfulness and suicidal ideation."

"seasonal pattern specifier"

A diagnostic qualifier indicating that mood episodes consistently occur at a particular time of year, typically winter depression

"Given her five consecutive years of winter depressive episodes with full remission in spring, a seasonal pattern specifier was added to the diagnosis."

"mood stabiliser"

A psychiatric medication used to prevent or reduce the severity of manic and depressive episodes in bipolar disorder

"Lithium remained the first-line mood stabiliser; serum levels were monitored every three months alongside thyroid and renal function."

"dysthymia"

A persistent but less severe form of depression lasting at least two years, characterised by chronically low mood

"He had never experienced a major depressive episode but described decades of persistent low mood consistent with a diagnosis of dysthymia."

"hypervigilance"

A state of heightened alertness and sensitivity to perceived threat, characteristic of post-traumatic stress disorder

"She reported hypervigilance that made it impossible to sit with her back to a door, scanning every room for exits upon entering."

"avoidance behaviour"

The deliberate steering away from situations, people, or thoughts associated with anxiety or traumatic memory

"His avoidance behaviour had progressively narrowed his world; he now rarely left the house and refused to travel by car."

"intrusive thoughts"

Unwanted, distressing mental images or thoughts that enter consciousness involuntarily, prominent in PTSD and OCD

"The patient described intrusive thoughts of the accident occurring multiple times daily, accompanied by intense physical anxiety."

"depersonalisation"

A dissociative experience in which a person feels detached from their own body or mental processes, as if observing themselves from outside

"During periods of extreme anxiety she experienced depersonalisation, describing herself as watching her own hands from the ceiling."

"compulsion"

A repetitive behaviour or mental act carried out in response to an obsession in an attempt to reduce anxiety or prevent a feared outcome

"His compulsions — checking the gas hob up to forty times before bed — were taking over three hours each evening."

"panic attack"

A discrete episode of intense fear with physical symptoms such as palpitations, dyspnoea, and dizziness, peaking within minutes

"She described her first panic attack as so severe she called an ambulance, convinced she was having a heart attack."

"generalised anxiety disorder"

A condition characterised by excessive, uncontrollable worry across multiple life domains, present more days than not for at least six months

"Despite no specific triggers, generalised anxiety disorder left him exhausted by perpetual catastrophic worry about health, finances, and family."

"exposure therapy"

A cognitive-behavioural technique in which the patient is systematically confronted with feared stimuli to reduce anxiety responses

"A graded hierarchy was devised and exposure therapy began with the least anxiety-provoking situation — looking at photographs of spiders."

"emotional dysregulation"

An inability to modulate the intensity or duration of emotional responses within a socially acceptable range

"Her emotional dysregulation was severe — minor criticism triggered hours of rage followed by profound shame and self-harm."

"splitting"

A primitive defence mechanism in which people or situations are viewed as entirely good or entirely bad, without integration

"Staff noticed splitting on the ward — the patient idealised night nurses while dismissing day staff as negligent and uncaring."

"impulsivity"

A tendency to act rapidly without forethought or regard for consequences, prominent in borderline and antisocial personality disorders

"His impulsivity had resulted in multiple unplanned job resignations, two failed marriages, and significant financial debt within a decade."

"dialectical behaviour therapy"

An evidence-based psychological treatment combining cognitive-behavioural techniques with mindfulness, developed specifically for borderline personality disorder

"Following commencement of dialectical behaviour therapy, the frequency of self-harm dropped from weekly to twice in the subsequent six months."

"mentalisation"

The capacity to understand one's own and others' mental states — thoughts, feelings, and intentions — underlying interpersonal behaviour

"Mentalisation-based treatment aimed to help her reflect on others' perspectives before reacting to perceived rejection."

"callous unemotional traits"

A specifier describing a lack of remorse, empathy, and emotional responsiveness associated with severe conduct problems

"The forensic assessment documented callous unemotional traits — he showed no remorse and described enjoying the distress of his victim."

"identity disturbance"

A markedly and persistently unstable sense of self, including goals, values, and self-image, central to borderline personality disorder

"Identity disturbance was pervasive; she described feeling empty inside and unable to say who she was or what she valued."

"therapeutic alliance"

The quality of the collaborative working relationship between clinician and patient, a key predictor of treatment outcome across psychotherapies

"Building a strong therapeutic alliance took eighteen months given her history of attachment trauma and distrust of healthcare professionals."

"selective serotonin reuptake inhibitor"

A class of antidepressant that blocks reabsorption of serotonin in the synapse, increasing its availability; first-line treatment for depression and many anxiety disorders

"She was commenced on a selective serotonin reuptake inhibitor with counselling regarding the two-week latency before therapeutic effect."

"tardive dyskinesia"

A potentially irreversible movement disorder characterised by repetitive involuntary movements, caused by prolonged dopamine receptor blockade from antipsychotic use

"After fifteen years on a first-generation antipsychotic, the patient developed tardive dyskinesia with continuous oro-facial movements."

"therapeutic drug monitoring"

Regular measurement of a drug's serum concentration to ensure levels remain within the therapeutic window and avoid toxicity

"Therapeutic drug monitoring confirmed a lithium level of 0.4 mmol/L — below the target range of 0.6–0.8 mmol/L — so the dose was increased."

"augmentation strategy"

The addition of a second agent to an existing medication regimen to enhance response in treatment-resistant conditions

"When the antidepressant alone proved insufficient, an augmentation strategy with low-dose quetiapine produced significant improvement within four weeks."

"anticholinergic side effect"

An adverse effect resulting from blockade of muscarinic receptors, including dry mouth, urinary retention, constipation, and blurred vision

"The patient tolerated the antidepressant poorly due to anticholinergic side effects — severe constipation and urinary hesitancy — necessitating a change."

"discontinuation syndrome"

A cluster of symptoms including dizziness, nausea, and flu-like malaise occurring when an antidepressant is stopped abruptly

"Having stopped her SSRI without medical advice, she presented with discontinuation syndrome characterised by electric-shock sensations and severe dizziness."

"polypharmacy"

The concurrent use of multiple medications, associated with increased risk of drug interactions and adverse effects, common in complex psychiatric presentations

"A medication review identified polypharmacy — the patient was prescribed seven psychotropic agents by three different clinicians without co-ordination."

"metabolic syndrome"

A cluster of cardiovascular risk factors — central obesity, dyslipidaemia, hypertension, and glucose intolerance — increased by many atypical antipsychotics

"Annual physical health monitoring revealed that the patient had developed metabolic syndrome after two years on olanzapine, requiring dietary and pharmacological intervention."

"suicidal ideation"

Thoughts of ending one's own life, assessed on a continuum from passive wish to die through to active planning and intent

"She disclosed active suicidal ideation with a specific plan to overdose, and was admitted under Section 2 of the Mental Health Act."

"insight"

The degree to which a patient recognises that they have a mental illness and that their experiences are symptoms requiring treatment

"He had limited insight, acknowledging that others found his behaviour concerning but firmly denying any mental illness."

"risk formulation"

A structured clinical appraisal integrating static and dynamic factors to estimate and contextualise an individual's risk of harm to self or others

"The risk formulation identified recent substance misuse and recent discharge from inpatient care as key dynamic risk factors requiring urgent community follow-up."

"capacity assessment"

A clinical evaluation of whether a patient can understand, retain, weigh, and communicate a decision about their own treatment

"A formal capacity assessment was conducted after the patient refused ECT; she was found to lack capacity due to severe depressive cognitive distortion."

"cognitive impairment"

Deficits in memory, attention, executive function, or other cognitive domains that interfere with daily functioning

"Neuropsychological testing confirmed significant cognitive impairment in working memory and processing speed, disproportionate to her age of fifty-two."

"protective factors"

Characteristics or circumstances that reduce the likelihood of adverse outcomes in a clinical risk assessment

"Despite high static risk, strong protective factors were identified: robust family support, abstinence from alcohol, and strong future orientation."

"mental state examination"

The systematic clinical assessment of a patient's current psychological functioning, covering appearance, behaviour, speech, mood, thought, perception, and cognition

"On mental state examination she appeared dishevelled, was thought-disordered with persecutory delusions, and denied suicidal ideation."

"compulsory admission"

Detention in a psychiatric inpatient facility without the patient's consent under the authority of mental health legislation

"After the patient refused voluntary admission despite high suicide risk, compulsory admission was authorised under Section 3 of the Mental Health Act."